Provider Demographics
NPI:1720175607
Name:DOAK, BARBARA D (RPH, CDE)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:D
Last Name:DOAK
Suffix:
Gender:F
Credentials:RPH, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 OAK GROVE LN
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-2555
Mailing Address - Country:US
Mailing Address - Phone:304-377-6442
Mailing Address - Fax:
Practice Address - Street 1:2300 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1045
Practice Address - Country:US
Practice Address - Phone:304-357-4854
Practice Address - Fax:304-357-4868
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03136342183500000X
WV4018183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003004Medicaid
WV0952-0470OtherCDE CERTIFICATION